Integrated Network Analysis of Toxic Elements Co-exposure and Pathophysiological Changes Triggered by Oxidative...

This study aimed to investigate the pathophysiological changes of urban sanitation workers caused by potentially toxic element (PTE) exposure with a network analysis approach. Ninety urban sanitation workers from Bushehr Municipal Organization (exposed group) and 90 janitorial staff members from academic, administrative, and institutional settings (control group) were included. The PTE levels in serum samples were quantified using inductively coupled plasma mass spectrometry (ICP-MS; Agilent 7500). Cytoscape software, version 3.10.3, was employed for network analysis and visualization. The concentration levels of PTEs in the exposed and control groups ranged from 0.65 (Co) to 1345 (Fe) and 0.23 (Cd) to 1287 (Fe) μg/L, respectively. The concentration levels of ∑PTEs in the exposed and control groups were 2986 ± 1655 and 2664 ± 1240 μg/L, respectively. The levels of some blood indices, such as white blood cell (WBC), red blood cell (RBC), hemoglobin (HB), mean corpuscular hemoglobin concentration (MCHC), lymphocytes, and eosinophils, were statistically different between the exposed and control groups (p < 0.001). The direct and weighted network analysis to visualize interactions between PTEs and biomarkers showed that As, Cd, and Pb emerged as the most influential PTEs, affecting multiple biomarkers with robust connections. The network analysis showed that oxidative stress/inflammatory markers, particularly 8-OHdG and TNF-α, act as key triggers mediating the adverse effects of PTEs on liver function (ALT, AST) and other physiological systems. The elevated exposure to hazardous elements among solid waste collectors poses a clear public health concern, and a comprehensive approach combining engineering controls, personal protective equipment (PPE), health monitoring, education, and policy enforcement is essential to protect workers' health.